AB0321 APPLICATION OF NOVEL REFERENCE VALUES FOR 24-HOUR PROFILE OF CENTRAL SYSTOLIC BLOOD PRESSURE IN RHEUMATOID ARTHRITIS: CORRESPONDENCE WITH PERIPHERAL BLOOD PRESSURE AND CLINICAL ASSOCIATIONS OF HYPERTENSIVE PHENOTYPES
Authors: R. Rakhmadzhanova, G. Farias, E. Troitskaya, R. Osipyants, S. Velmakin, Z. Kobalava
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Prognostic significance of 24-h profile of peripheral BP is well-known. The growing insights in the role of arterial stiffening in cardiovascular disease led to the viewpoint that vascular risk must be more closely associated with central than brachial BP. While the upper limits for clinic and ambulatory peripheral BP have been routinely used for a long time and the reference values for clinical central BP have been developed some years ago, the hypertensive threshold for 24-h central BP hasn`t been investigated until 2022. <h3>Objectives</h3> To apply novel reference values of 24-h central SBP (cSBP) in the patients with rheumatoid arthritis and to characterize the hypertensive profile. <h3>Methods</h3> The study group included 85 patients with RA (females 77.6%, age 59.7±14.3 (M±SD) years, HTN 65%, median HTN duration 6.6 years, RA duration – 7 years seropositive RA 65%, mean DAS-28(CRP) 3.7±1.1) and control group (40 patients matched by gender, age and risk factors). All patients with HTN received antihypertensive therapy. Office peripheral BP was measured with a validated oscillometric device, 24-hour ABPM was performed with BPLab Vasotens, arterial stiffness – by applanation tonometry. CV risk was calculated by mSCORE (EULAR recommended modified version). The upper limits for normal central SBP were 125 mmHg for daytime, 115 mmHg for nighttime and 120 mmHg for 24-h BP. P&lt;0.05 was considered significan.t. <h3>Results</h3> Mean central SBP in patients with RA was 123±21 mmHg (108±13 mmHg in normotensive and 132±20 in hypertensive patients, p&lt;0.05). Hypertensive patients with RA vs controls were characterized by significantly higher frequency of elevation of daytime cSBP (44.1% vs 12.5%, p=0.01) and a trend to higher frequency of elevation of nighttime cSBP (58.8% vs 37.5%, p=0,09) and 24-h SBP (47.1% vs 25%, p=0.05). In normotensive RA patients compared to controls cSBP was elevated in 7.1% vs 0% for daytime, 14.3% vs 0% for nighttime and 7.1% vs 0% for 24H BP respectively (p&gt;0.05 or the trend). All patients with normal peripheral ambulatory SBP (daytime, nighttime and 24-h) had normal central ambulatory SBP. 2 patients with elevated 24-h pSBP and 5 patients with elevated nighttime pSBP had normal cSBP while 2 patients with normal daytime pSBP had elevated cSBP. Patterns of diurnal index were similar for peripheral and central SBP (the discordance was observed only in 4 patients who were dippers by peripheral BP and non-dippers by central). Patients with RA and central 24-h BP elevation compared to patients with normal profile had higher ESR, longer RA duration, higher BMI, higher frequency of obesity, HTN, longer duration of HTN, higher cfPWV, central pulse pressure, stiffness gradient (cfPWV/crPWV), CAVI and higher CV risk. There were significant correlations between central 24-h BP elevation and ESR, hypertension-related parameters (PWV, pulse pressure, stiffness gradient, CAVI) and SCORE index. <h3>Conclusion</h3> The first application of novel reference values of ambulatory cSBP in RA showed that cSBP elevation is highly prevalent and in hypertensive individuals the frequency of daytime cSBP elevation is higher than in controls. Not only hypertension related parameters but also high ESR may be the markers of 24-h cSBP elevation. <h3>Reference</h3> [1] Weber T, Protogerou A, Agharazii M et al. Twenty-Four–Hour Central (Aortic) Systolic Blood Pressure: Reference Values and Dipping Patterns in Untreated Individuals. Hypertension. 2022;79:251–260. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> Ravshanoi Rakhmadzhanova: None declared, Geovanny Farias: None declared, Elena Troitskaya: None declared, Rita Osipyants: None declared, Sergei Velmakin: None declared, Zhanna Kobalava Speakers bureau: Servier, Pfizer, Astra-Zeneca.